Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2010

01-05-2010 | Colorectal Cancer

Management of Recurrent Rectal Cancer

Authors: Philippe Bouchard, MD, FRCSC, Jonathan Efron, MD, FACS, FASCRS

Published in: Annals of Surgical Oncology | Issue 5/2010

Login to get access

Abstract

Background

Here we present a concise review on the evaluation and management of locally recurrent rectal cancer, which despite marked reductions in the rate of recurrent rectal cancer remains an important problem.

Methods

This educational review discusses the diagnosis, evaluation, and management of recurrent rectal cancer.

Results

Despite improvements in both the neoadjuvant and surgical management of rectal cancer, local recurrence is still an important problem, with documented recurrence rates of 4% to 8%. The local management of recurrence requires a team of specialist. Accurate detection and diagnosis followed by chemoradiotherapy and surgical resection may result in 5-year survival rates of up to 35%.

Conclusions

We discuss the diagnosis, evaluation, and management of locally recurrent rectal cancer. Locally recurrent rectal cancer can be successfully managed with multimodal therapy leading to successful palliation and often cure.
Literature
1.
Heald RJ, Moran BJ, Ryall RD, Sexton R, MacFarlane JK. Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 1998;133:894–9.CrossRefPubMed
2.
Davies M, Harries D, Hirst G, et al. Local recurrence after abdomino-perineal resection. Colorectal Dis 2009;11:39–43.CrossRefPubMed
3.
Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638–46.CrossRefPubMed
4.
Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 2004;351:1731–40.CrossRefPubMed
5.
Gunderson LL, Sosin H. Areas of failure found at reoperation (second or symptomatic look) following “curative surgery” for adenocarcinoma of the rectum. Clinicopathologic correlation and implications for adjuvant therapy. Cancer 1974;34:1278–92.CrossRefPubMed
6.
Palmer G, Martling A, Cedermark B, Holm T. A population-based study on the management and outcome in patients with locally recurrent rectal cancer. Ann Surg Oncol 2007;14:447–54.CrossRefPubMed
7.
Bakx R, Visser O, Josso J, et al. Management of recurrent rectal cancer: a population based study in greater Amsterdam. World J Gastroenterol 2008;14:6018–23.CrossRefPubMed
8.
Kim YW, Kim NK, Min BS, et al. Factors associated with anastomotic recurrence after total mesorectal excision in rectal cancer patients. J Surg Oncol 2009;99:58–64.CrossRefPubMed
9.
Dent OF, Haboubi N, Chapuis PH, et al. Assessing the evidence for an association between circumferential tumour clearance and local recurrence after resection of rectal cancer. Colorectal Dis 2007;9:112–21.CrossRefPubMed
10.
Birbeck KF, Macklin CP, Tiffin NJ, et al. Rates of circumferential resection margin involvement vary between surgeons and predict outcomes in rectal cancer surgery. Ann Surg 2002;235:449–57.CrossRefPubMed
11.
Nagtegaal ID, Marijnen CA, Kranenbarg EK, van de Velde CJ, van Krieken JH. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 2002;26:350–7.CrossRefPubMed
12.
Shirouzu K, Isomoto H, Kakegawa T. Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery. Cancer 1995;76:388–92.CrossRefPubMed
13.
Moore HG, Riedel E, Minsky BD, et al. Adequacy of 1-cm distal margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined-modality therapy. Ann Surg Oncol 2003;10:80–5.CrossRefPubMed
14.
Stocchi L, Nelson H, Sargent DJ, et al. Impact of surgical and pathologic variables in rectal cancer: a United States community and cooperative group report. J Clin Oncol 2001;19:3895–902.PubMed
15.
Ogiwara H, Nakamura T, Baba S. Variables related to risk of recurrence in rectal cancer without lymph node metastasis. Ann Surg Oncol 1994;1:99–104.CrossRefPubMed
16.
Tilney HS, Tekkis PP, Sains PS, Constantinides VA, Heriot AG. Factors affecting circumferential resection margin involvement after rectal cancer excision. Dis Colon Rectum 2007;50:29–36.CrossRefPubMed
17.
Moore HG, Shoup M, Riedel E, et al. Colorectal cancer pelvic recurrences: determinants of resectability. Dis Colon Rectum 2004;47:1599–606.CrossRefPubMed
18.
Heriot AG, Byrne CM, Lee P, et al. Extended radical resection: the choice for locally recurrent rectal cancer. Dis Colon Rectum 2008;51:284–91.CrossRefPubMed
19.
Hahnloser D, Nelson H, Gunderson LL, et al. Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg 2003;237:502–8.CrossRefPubMed
20.
Hashiguchi Y, Sekine T, Sakamoto H, et al. Intraoperative irradiation after surgery for locally recurrent rectal cancer. Dis Colon Rectum 1999;42:886–93.CrossRefPubMed
21.
Beets-Tan RG, Beets GL, Borstlap AC, et al. Preoperative assessment of local tumor extent in advanced rectal cancer: CT or high-resolution MRI? Abdom Imaging 2000;25:533–41.CrossRefPubMed
22.
Messiou C, Chalmers AG, Boyle K, Wilson D, Sagar P. Pre-operative MR assessment of recurrent rectal cancer. Br J Radiol 2008;81(966):468–73.CrossRefPubMed
23.
Chen CC, Lee RC, Lin JK, Wang LW, Yang SH. How accurate is magnetic resonance imaging in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy? Dis Colon Rectum 2005;48:722–8.CrossRefPubMed
24.
Messiou C, Chalmers A, Boyle K, Sagar P. Surgery for recurrent rectal carcinoma: the role of preoperative magnetic resonance imaging. Clin Radiol 2006;61:250–8.CrossRefPubMed
25.
Chessin DB, Kiran RP, Akhurst T, Guillem JG. The emerging role of 18F-fluorodeoxyglucose positron emission tomography in the management of primary and recurrent rectal cancer. J Am Coll Surg 2005;201:948–56.CrossRefPubMed
26.
Watson AJ, Lolohea S, Robertson GM, Frizelle FA. The role of positron emission tomography in the management of recurrent colorectal cancer: a review. Dis Colon Rectum 2007;50:102–14.CrossRefPubMed
27.
Faneyte IF, Dresen RC, Edelbroek MA, Nieuwenhuijzen GA, Rutten HJ. Pre-operative staging with positron emission tomography in patients with pelvic recurrence of rectal cancer. Dig Surg 2008;25:202–7.CrossRefPubMed
28.
Schurr P, Lentz E, Block S, et al. Radical redo surgery for local rectal cancer recurrence improves overall survival: a single center experience. J Gastrointest Surg 2008;12:1232–8.CrossRefPubMed
29.
Yiu R, Wong SK, Cromwell J, et al. Pelvic wall involvement denotes a poor prognosis in T4 rectal cancer. Dis Colon Rectum 2001;44:1676–81.CrossRefPubMed
30.
Moriya Y, Akasu T, Fujita S, Yamamoto S. Total pelvic exenteration with distal sacrectomy for fixed recurrent rectal cancer in the pelvis. Dis Colon Rectum 2004;47:2047–53.CrossRefPubMed
31.
Suzuki K, Gunderson LL, Devine RM, et al. Intraoperative irradiation after palliative surgery for locally recurrent rectal cancer. Cancer 1995;75:939–52.CrossRefPubMed
32.
Dresen RC, Gosens MJ, Martijn H, et al. Radical resection after IORT-containing multimodality treatment is the most important determinant for outcome in patients treated for locally recurrent rectal cancer. Ann Surg Oncol 2008;15:1937–47.CrossRefPubMed
33.
Bosset JF, Calais G, Mineur L, et al. Enhanced tumorocidal effect of chemotherapy with preoperative radiotherapy for rectal cancer: preliminary results—EORTC 22921. J Clin Oncol 2005;23:5620–7.CrossRefPubMed
34.
Tulchinsky H, Shmueli E, Figer A, Klausner JM, Rabau M. An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol 2008;15:2661–7.CrossRefPubMed
35.
Mohiuddin M, Marks G, Marks J. Long-term results of reirradiation for patients with recurrent rectal carcinoma. Cancer 2002;95:1144–50.CrossRefPubMed
36.
Valentini V, Morganti AG, Gambacorta MA, et al. Preoperative hyperfractionated chemoradiation for locally recurrent rectal cancer in patients previously irradiated to the pelvis: a multicentric phase II study. Int J Radiat Oncol Biol Phys 2006;64:1129–39.PubMed
37.
Gunderson LL, Nelson H, Martenson JA, et al. Intraoperative electron and external beam irradiation with or without 5-fluorouracil and maximum surgical resection for previously unirradiated, locally recurrent colorectal cancer. Dis Colon Rectum 1996;39:1379–95.CrossRefPubMed
38.
Lanciano RM, Calkins AR, Wolkov HB, et al. A phase I/II study of intraoperative radiotherapy in advanced unresectable or recurrent carcinoma of the rectum: a Radiation Therapy Oncology Group (RTOG) study. J Surg Oncol 1993;53:20–9.CrossRefPubMed
39.
Mannaerts GH, Rutten HJ, Martijn H, Hanssens PE, Wiggers T. Comparison of intraoperative radiation therapy-containing multimodality treatment with historical treatment modalities for locally recurrent rectal cancer. Dis Colon Rectum 2001;44:1749–58.CrossRefPubMed
40.
Shoup M, Guillem JG, Alektiar KM, et al. Predictors of survival in recurrent rectal cancer after resection and intraoperative radiotherapy. Dis Colon Rectum 2002;45:585–92.CrossRefPubMed
41.
Nuyttens JJ, Kolkman-Deurloo IK, Vermaas M, et al. High-dose-rate intraoperative radiotherapy for close or positive margins in patients with locally advanced or recurrent rectal cancer. Int J Radiat Oncol Biol Phys 2004;58:106–12.CrossRefPubMed
42.
Mannaerts GH, Martijn H, Crommelin MA, et al. Intraoperative electron beam radiation therapy for locally recurrent rectal carcinoma. Int J Radiat Oncol Biol Phys 1999;45:297–308.PubMed
43.
Lindel K, Willett CG, Shellito PC, et al. Intraoperative radiation therapy for locally advanced recurrent rectal or rectosigmoid cancer. Radiother Oncol 2001;58:83–7.CrossRefPubMed
44.
Wiig JN, Tveit KM, Poulsen JP, Olsen DR, Giercksky KE. Preoperative irradiation and surgery for recurrent rectal cancer. Will intraoperative radiotherapy (IORT) be of additional benefit? A prospective study. Radiother Oncol 2002;62:207–13.CrossRefPubMed
45.
Harrison LB, Minsky BD, Enker WE, et al. High dose rate intraoperative radiation therapy (HDR-IORT) as part of the management strategy for locally advanced primary and recurrent rectal cancer. Int J Radiat Oncol Biol Phys 1998;42:325–30.PubMed
46.
Alektiar KM, Zelefsky MJ, Paty PB, et al. High-dose-rate intraoperative brachytherapy for recurrent colorectal cancer. Int J Radiat Oncol Biol Phys 2000;48:219–26.CrossRefPubMed
47.
Gunderson LL, Martin JK, Beart RW, et al. Intraoperative and external beam irradiation for locally advanced colorectal cancer. Ann Surg 1988;207:52–60.CrossRefPubMed
48.
Saito N, Koda K, Takiguchi N, et al. Surgery for local pelvic recurrence after resection of rectal cancer. Int J Colorectal Dis 1998;13:32–8.CrossRefPubMed
49.
Saito N, Koda K, Takiguchi N, et al. Curative surgery for local pelvic recurrence of rectal cancer. Dig Surg 2003;20:192–9.CrossRefPubMed
50.
51.
Bullard KM, Trudel JL, Baxter NN, Rothenberger DA. Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure. Dis Colon Rectum 2005;48:438–43.CrossRefPubMed
52.
Artioukh DY, Smith RA, Gokul K. Risk factors for impaired healing of the perineal wound after abdominoperineal resection of rectum for carcinoma. Colorectal Dis 2007;9:362–7.CrossRefPubMed
53.
Butler CE, Gundeslioglu AO, Rodriguez-Bigas MA. Outcomes of immediate vertical rectus abdominis myocutaneous flap reconstruction for irradiated abdominoperineal resection defects. J Am Coll Surg 2008;206:694–703.CrossRefPubMed
54.
Abbott DE, Halverson AL, Wayne JD, et al. The oblique rectus abdominal myocutaneous flap for complex pelvic wound reconstruction. Dis Colon Rectum 2008;51:1237–41.CrossRefPubMed
55.
Wille-Jorgensen P, Pilsgaard B, Moller P. Reconstruction of the pelvic floor with a biological mesh after abdominoperineal excision for rectal cancer. Int J Colorectal Dis 2009;24:323–5.CrossRefPubMed
56.
Willett CG, Gunderson LL. Palliative treatment of rectal cancer: is radiotherapy alone a good option? J Gastrointest Surg 2004;8:277–9.CrossRefPubMed
57.
Hunerbein M, Krause M, Moesta KT, Rau B, Schlag PM. Palliation of malignant rectal obstruction with self-expanding metal stents. Surgery 2005;137:42–7.CrossRefPubMed
58.
Song HY, Kim JH, Kim KR, et al. Malignant rectal obstruction within 5 cm of the anal verge: is there a role for expandable metallic stent placement? Gastrointest Endosc 2008;68:713–20.CrossRefPubMed
59.
Nash GM, Saltz LB, Kemeny NE, et al. Radical resection of rectal cancer primary tumor provides effective local therapy in patients with stage IV disease. Ann Surg Oncol 2002;9:954–60.CrossRefPubMed
60.
Boyle KM, Sagar PM, Chalmers AG, et al. Surgery for locally recurrent rectal cancer. Dis Colon Rectum 2005;48:929–37.CrossRefPubMed
61.
Wiig JN, Poulsen JP, Larsen S, et al. Total pelvic exenteration with preoperative irradiation for advanced primary and recurrent rectal cancer. Eur J Surg 2002;168:42–8.CrossRefPubMed
Metadata
Title
Management of Recurrent Rectal Cancer
Authors
Philippe Bouchard, MD, FRCSC
Jonathan Efron, MD, FACS, FASCRS
Publication date
01-05-2010
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 5/2010
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0861-2

Other articles of this Issue 5/2010

Annals of Surgical Oncology 5/2010 Go to the issue

Translational Research and Biomarkers

p21 Waf1/Cip1 Polymorphisms and Risk of Esophageal Cancer

EMERGING THERAPEUTIC APPROACHES TO HEPATOCELLULAR CARCINOMA

Systemic Treatment of Hepatocellular Carcinoma: Dawn of a New Era?

Melanomas

Validation Study of the S Classification for Melanoma Patients with Positive Sentinel Nodes: The Montreal Experience

EDUCATIONAL REVIEW – EMERGING THERAPEUTIC APPROACHES TO HEPATOCELLULAR CARCINOMA

Emerging Therapeutic Approaches to Hepatocellular Carcinoma

Gastrointestinal Oncology

Is Lymphadenectomy a Predictor or Savior for Patients with Gastric Cancer?

Bone and Soft Tissue Sarcomas

A Systematic Review and Meta-Analysis of Oncologic Outcomes of Pre- Versus Postoperative Radiation in Localized Resectable Soft-Tissue Sarcoma